DAYTON DAILY NEWS
Sunday, October 24, 1999Newest of Canadian exports: Surgery
Eye doctors there charge thousands less
By Tom Beyerlein
MIAMI TWP., Montgomery County--Angela Colton and Michelle Daly will travel to Canada for three days in January. They hope to come home without their contact lenses.
The two friends, who work at Lexis-Nexis in Miami Twp., are part of a wave of U.S. citizens who are making a run for the border to get one of America's most popular surgeries, the LASIK corrective eye surgery. Lasik Vision Canada Inc., Canada's largest LASIK provider, says 40 to 50 percent of its 30,000 patients annually come from the United States.
The reason: Canadian doctors charge considerably less than their U.S. counterparts for laser-assisted in situ keratomileusis, which corrects nearsightedness, farsightedness and astigmatism.
Lasik Vision Canada, which is doing the local women's surgeries, charges $999 to U.S. customers--$600 less than it charges Canadians. By comparison, it costs about $4,500 to have the surgery in the United States. Canada's discounting has even set off surgical price wars in some border towns.
Colton, 29, of Englewood, and Daly, 40, of Middletown, report to Windsor, Ontario for pre-operative testing on Jan. 26, with surgery set for Jan. 28.
They say U.S. doctors are gouging the public and working to discourage people from taking advantage of Canada's lower prices. They say they've done extensive research and are confident the laser surgery performed in Canada is as safe and effective as it is in the States. But they've been unable to find any local optometrists willing to see them for a series of post-surgical checkups unless they use a local surgeon.
"It's a money racket, in my honest opinion," said Colton, 29, of Englewood, a content manager for Lexis-Nexis. "It makes me mad because it's all about money."
"Discount eye surgery is like a discount parachute," countered Dr. Brian Stahl of Kettering and Beavercreek, who said he performs 80 percent of LASIK surgeries in the Miami Valley. "Quite literally, you get what you pay for."
In LASIK, a surgeon makes an incision and lifts back a flap of the cornea's outer layer, then uses a laser to resculpt the cornea so it does a better job of focusing light on the retina. Unlike previous corrective surgeries, LASIK doesn't sunder the outer layer, speeding healing.
The U.S. Food and Drug Administration approved LASIK in 1996. Canadian doctors have been performing the procedure since the early '90s.
Why is LASIK so much more expensive in the U.S.? Some critics say it's simply because American doctors charge too much.
Canadian doctors often do earn less, but Stahl said it's more complicated than that. For one thing, the high volume of patients at Canadian LASIK centers helps to spread out the half-million-dollar cost of the laser and the other overhead.
The Canadians also use a different laser, which has not yet received FDA approval. They therefore don't pay a royalty that U.S. doctors must pay to the laser manufacturer, which adds $520 to each surgery. A favorable currency exchange rate doesn't hurt, either.
But Stahl said it's worth it to pay extra for local care. He called the Canadian facilities surgery mills. "I'm not saying it doesn't work, but it's not hand-holding, personal care. This is a big-money business for these Canadian companies. These corporations are here to make money. We (U.S. doctors) are here to make money, but the primary concern is to take care of our patients."
A July article in the professional journal Ophthalmology Management contended the Canadian clinics and other discounters are trying to drive traditional ophthalmologists out of the LASIK business and capture the market.
"Their goal seems to be to intentionally drive doctors out of the market," warned the journal. If discounters gain enough market share, "they can potentially ratchet the fee back up and increase their long-term margins. In other words, the discounters' short-term goal isn't profit--it's putting you out of business."
James Watson, executive vice president of Lasik Vision Canada, said the company simply is providing a popular procedure at an affordable cost.
When the company was founded in July 1997, its fees were comparable to those in the United States, Watson said. But in February 1998, Lasik Vision slashed its prices by marketing directly to the public, rather than paying co-management or referral fees to optometrists.
The company has in-house optometrists who provide followup care, but critics say it's unlikely that many U.S. patients will return to Canada for recommended checkups one week, one month and three months after surgery. Colton and Daly plan to drive to Canada for the checkups, since they say they can't find a willing local doctor.
Colton's optometrist, Dr. James Ranft of Tipp City, said he declined to offer Colton post-surgical care because he doesn't want to be medically--or, potentially, legally--responsible for the work of a surgeon he doesn't know. There are risks to LASIK, although the complication rate is less than one percent.
"In the rare situation where there are complications, I am left holding the bag," Ranft said. "It puts us in a very awkward position. It's not that I don't want to care for this patient. It's just that I don't want the medical and legal responsibility if something goes wrong."
Colton said she had been thinking of having the procedure for months when a co-worker returning from a trip to Canada told her about the discounts. She told Daly about it.
"It was like, 'Geez, how can you pass up a deal like this, even if you have to drive to Canada?'" said Daly, a Lexis-Nexis product analyst.
The women did their homework. They searched on-line for any research proving substandard LASIK care in Canada. They didn't find any. And they checked out the background of the surgeon assigned to their case. They were well satisfied with what they learned.
"They (U.S. doctors) say, 'You're going to trust your eyes to somebody you don't know?' Well, I don't know them, either," Colton said. "It just takes money out of their pockets--that's what they don't like about it."